University of Windsor Scholarship at UWindsor International Symposium on Arab Youth Conference Presentations May 30th, 11:15 AM - 12:30 PM Mental Illness and Chronic Disease in a Random Sample of Newly-Arrived Refugees and Immigrants to the U.S. Hikmet Jamil Wayne State University Bengt B. Arnetz Wayne State University Ghosh Samiran Wayne State University Judith E. Arnetz Wayne State University Follow this and additional works at: https://scholar.uwindsor.ca/arabyouthsymp Part of the Psychology Commons Jamil, Hikmet; Arnetz, Bengt B.; Samiran, Ghosh; and Arnetz, Judith E., "Mental Illness and Chronic Disease in a Random Sample of Newly-Arrived Refugees and Immigrants to the U.S." (2013). International Symposium on Arab Youth. 5. https://scholar.uwindsor.ca/arabyouthsymp/conference_presentations/presentations2/5 This Event is brought to you for free and open access by the Department of Psychology at Scholarship at UWindsor. It has been accepted for inclusion in International Symposium on Arab Youth by an authorized administrator of Scholarship at UWindsor. For more information, please contact scholarship@uwindsor.ca.
Presenter: Hikmet Jamil, MD, DVD, DIH, MSc, PhD, FFOM, MFOM Research Team: Arnetz, B., MD, PhD, Ager, J., PhD and Arnetz J., PhD, MPH Department of Family Medicine & Public Health Sciences Division of Occupational & Environmental Health School of Medicine Wayne State University Detroit Michigan USA 1
To Examine: Objective The prevalence of chronic diseases [Hypertension, Heart diseases, Asthma and Diabetes] among newly arrived refugees and immigrants to U.S. Predict the risk factors for each of the four chronic diseases studied. If self-reported mental illnesses [Depression and PTSD] have an impact on the occurrence of chronic diseases. 2
Hypothesis We predicted that Iraqi Refugees would report Higher Prevalence of Chronic Diseases when compared with Arab non-iraqi immigrants as a control group. We predict that Mental Illnesses could have an Impact on Chronic Diseases among Refugees, more so than immigrants. 3
Background Research linking Chronic disease to Mental disorders among refugees/immigrants is still not clear. Most prior research on refugees/immigrant has been based on convenience samples; has lacked culturallysimilar comparison groups; and was conducted years after arrival to host country. Most previous research on refugee has focused mainly on Mental Disorders, with less emphasis on Chronic Diseases. Differences exist in the prevalence of Chronic Diseases between refugees from different countries and between refugees and immigrants or the U.S. norm population (higher or lower). 4
Methods A random sample of Iraqi refugees (n=298) & convenient random sample of Arab immigrants (Not Iraqi) (n=313) were participates in this study. The recruitment criteria: Age 18 years or above Less than one year since entering U.S. for refugees and a maximum of 2 years for immigrants. The instruments was translated into Arabic language and re-translated into English to ensure reliability. 5
Methods Participants were interviewed using a different standards questionnaire. E.g. Pre-migration trauma exposure. The Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992) was used to assess pre-migration trauma exposure (39 self-report items). PTSD symptoms was used to assess the civilian version of the PTSD checklist (PCL-C), which includes 17 selfreport items). Depression symptoms were assessed by the 7-item depression subscale of the Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983) 6
Methods The question on the four Chronic Diseases was as follows: Have you been diagnosed by your doctor with any of the following? The four chronic diseases were listed for the participant to choose as applies, with either yes, no, or don t know for each disease. Current stressor (based on a Likert-type scale, a 5-point scale ranging from 1(Not at all) to 5). Binary logistic regression modeling was used in estimating the strength of the association between refugees and immigrants in the presence or absence of each chronic disease as well as determining the predictors of for each chronic disease 7
Variable Non Significant Demography Variables among study population Immigrant Refugees (n=313)x (n=298)x Age / Mean (SD) 33.4(11.28) 32.4(11.52) Gender Female 135(43%) 137(46) Male 179(57%) 161(54%) Drink alcohol Don't drink alcohol 62(20%) 60(20%) Drink alcohol 248(80%) 238(80%) Tobacco consumption Don't smoke tobacco 218(69%) 190(64%) Smoke tobacco 96(31%) 108(36%) 8
Variable Significant Demographic Variables among Study Population (P < 0.001) Marital Status Immigrant (n=313) Refugees (n=298) Single /never married 90(29%) 132(44%) Married/Other 224(71%) 166(56%) Education High School or Less 170(54%) 212(71%) Greater than High School 144(46%) 85(29%) 9
Mean months of Period Spent by Study Group *P < 0.001 29.0 Refugees (n=298) 4.8 1.0 8.1 Immigrant (n=314) Months Out US* Months In US* 10
Mean Scale of Certain Variables among Study Population *P < 0.001 26.30 24.7 Refugees (n=298) Immigran t (n=314) 12.50 2.4 BMI* Home Trauma* 11
Prevalence of Mental Illnesses among Study Population *P< 0.05 10.1 15.8 Refugees (n=298) 0.7 1.9 Immigra nt (n=314) Depression * PTSD 12
Prevalence of Chronic Diseases among Study Population P = n.s. for each 9.7 8.7 6.4 Refugees (n=298) Immigrant (n=314) 4.7 3.7 3.7 3.2 2.6 Hypertension Diabetes Heart disease Asthma 13
Binary Logistic Regression Analysis to Predict Risk Factors for Hypertension Likelihood of having Odds 95% C.I.for OR Sig. Hypertension Ratios Lower Upper Age.000 1.1 1.07 1.19 Have high Cholesterol.021 2.9 1.18 7.36 BMI.001 1.1 1.05 1.19 Back Home Trauma.011 1.2 1.04 1.31 Immigrants vs Refugees {R].051 6.7 0.99 44.81 Depression.288 1.01 0.95 1.19 PTSD.339 1.03 0.97 1.09 Variable(s) entered on analysis: Age, Sex, Marital, Education, Health Insurance, Country of origin, Cholesterol, Tobacco, Alcohol, BMI, Back Home Trauma, Depression, PTSD, Refugees/Immigrant, Months out US, Months in US, Current Stress, Diabetes, Hypertension, Asthma. 14
Binary Logistic Regression Analysis to Predict Risk Factors for Heart Disease Likelihood of having Odds 95% C.I.for OR Sig. Heart Disease Ratios Lower Upper Have high Cholesterol.007 8.5 1.80 39.70 Smoke Tobacco.046 5.0 1.03 24.77 Asthma.018 13.9 1.57 123.30 Immigrants vs Refugees {R].650 2.1 0.09 51.56 Depression.609 1.048 0.88 1.26 PTSD.549 1.025 0.95 1.11 Variable(s) entered on analysis: Age, Sex, Marital, Education, Health Insurance, Country of origin, Cholesterol, Tobacco, Alcohol, BMI, Back Home Truma, Depression, PTSD, Refugees/Immigrant, Months out US, Months in US, Current Stress, Diabetes, Hypertension, Asthma. 15
Binary Logistic Regression Analysis to Predict Risk Factors for Diabetes Mellitus Likelihood of having Diabetes Mellitus Sig. Odds Ratios 95% C.I.for OR Lower Upper Age.000 1.1 1.07 1.20 Immigrants vs Refugees [R].996 1.0 0.13 7.99 Depression.856 0.9 0.85 1.13 PTSD.883 0.9 0.92 1.07 Variable(s) entered on analysis: Age, Sex, Marital, Education, Health insurance, Country of origin, Cholesterol, Tobacco, Alcohol, BMI, Back Home Trauma, Depression, PTSD, Refugees/Immigrant, Months out US, Months in US, Current Stress, Diabetes, Hypertension, Asthma. 16
Binary Logistic Regression Analysis to Predict Risk Factors for Asthma Likelihood of having Asthma Sig. Odds Ratios 95% C.I.for OR Lower Upper Age.028 1.1 1.01 1.14 Heart disease.034 6.6 1.15 37.99 Immigrants vs Refugees{R].996 1.0 0.13 7.99 Depression.764 1.025 0.87 1.20 PTSD.477.962 0.87 1.07 Variable(s) entered on analysis: Age, Sex, Marital, Education, Health Insurance, Country of origin, Cholesterol, Tobacco, Alcohol, BMI, Back Home Trauma, Depression, PTSD, Refugees/Immigrant, Months out US, Months in US, Current Stress, Diabetes, Hypertension, Asthma. 17
Binary Logistic Regression Analysis to Predict Risk Factors for One or more chronic diseases Likelihood of having One or more chronic diseases Sig. Odds Ratios 95% C.I.for OR Lower Upper Age.000 1.1 1.08 1.16 Have high Cholesterol.005 3.1 1.39 6.80 BMI.020 1.1 1.01 1.11 Immigrants vs Refugees {R].506 1.6 0.41 6.09 DepressionSum.550.97 0.88 1.06 PTSD_Scale.080 1.04 0.99 1.09 Variable(s) entered on analysis: Age, Sex, Marital, Education, Health insurance, Country of origin, Cholesterol, Tobacco, Alcohol, BMI, Back Home Trauma, Depression, PTSD, Refugees/Immigrant, Months out US, Months in US, Current Stress, 18
Structure Equation Modle (SEM) Now we are working on Path analysis or what is called Structure Equation Model (SEM) to examine if there is a link between Mental Disorders and any of the four Chronic Diseases Unfortunately till now we did not finish the analysis 19
Binary Logistic Regression Analysis to Predict Risk Factors for Current Self-Rated Health Likelihood of having Excellent to Good Health Sig. Odds Ratios 95% C.I.for OR Lower Upper Months In US (-B).020 0.9 0.74 0.97 Depression (- B).001 0.8 0.75 0.93 Immigrants vs Refugees{R].053 6.8 0.97 46.95 DepressionSum.550.97 0.88 1.06 PTSD_Scale.080 1.04 0.99 1.09 Variable(s) entered on analysis: Age, Sex, Marital, Education, Health insurance, Country of origin, Cholesterol, Tobacco, Alcohol, BMI, Back Home Trauma, Depression, PTSD, Refugees/Immigrant, Months out US, Months in US, Current Stress, 20
Binary Logistic Regression Analysis to Predict Risk Factors for Current Self-Mental Health Likelihood of having Excellent to Good Health Sig. Odds Ratios 95% C.I.for OR Lower Upper Immigrants vs Refugees[R].016 8.9 1.51 52.91 Month in US (- B).012 0.9 0.75 0.97 Depression (- B).000 0.7 0.66 0.82 PTSD (- B).011 0.9 0.88 0.98 Variable(s) entered on analysis: Age, Sex, Marital, Education, Health insurance, Country of origin, Cholesterol, Tobacco, Alcohol, BMI, Back Home Trauma, Depression, PTSD, Refugees/Immigrant, Months out US, Months in US, Current Stress, 21
Conclusion Our hypothesis was rejected as there were no impact of mental illnesses on any single chronic disease studied [hypertension, heart disease, diabetes and asthma] There were no significant differences in any of the chronic diseases studied between Refugees and Immigrants The predictor risk factors for each of the chronic diseases was identified. 22
Conclusion There were significant difference between Refugees and Immigrants when they rated themselves in one year time for both General Health and Mental Health. There were significant correlation between SRH and SMH when tested Refugees only or Immigrants only. 23
Acknowledgments Drs. Jamil, Arnetz B. and Arnetz, J. were partly supported by Award Number R01MH085793 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of the Mental Health or the National Institutes of Health. 24
25